Maximising practice learning

March 2015

Francis Thompson

Aims

Think about the process of mentorship and

some pitfalls

Consider the importance of making

space/time

Provide a framework to support the

process of mentorship

Consider skills

Develop a more reflective stance towards

mentoring

Role of the mentor

What makes a marmite mentor?

Stretching and challenging students

Asking challenging questions to promote

learning (50% of their learning is in

practice i.e. from you and your teams)

Supporting people while stretching and

challenging

Don’t be afraid to teach skills as well as

assessing them

Why is this mythological dude

important to mentorship?

Implicit bias

Views and opinions that we may not be aware

of; evaluations that are automatically triggered

when we encounter different people or

situations, commonly function without a person’s

full awareness or control (Greenwald and Banaji,

1995).

Understanding what causes it, how it impacts

decision making and what can be done to

moderate it is important.

The challenge for mentors Leutner

et al (2008)

Intrinsic difficulty in assessing competence

in nursing

Just because a person is capable of

demonstrating a skill in an assessment,

this does not readily translate into the

ability or inclination to use these skills

appropriately in practice

“I had a gut feeling about”

‘How did you feel about that?’

Emotions are information.

Feelings are inevitable (unless you are not

human!)

Reflecting on why you are having these

feelings is vital (positive and negative)

Enabling you to describe and articulate

these issues to the student and promoting

good feedback and learning

Skills vs fitting in OR Skills vs attitude

Using documentation to create and frame

conversations

Importance of clearly identifying goals and

expectations early

Difficulty in articulating concerns or why

you think the person is good, reflecting on

these is a powerful tool

Modelling skills and role

modelling Ask student to describe what you are

doing and why you are doing it

Allows you to get some feedback and

check underpinning understanding

Check in on approach as well as process

What did you observe, why did I do it that

way, what would can you take from this,

can you now demonstrate…..

Assessment vs teaching and

learning How far do you see yourself as an

assessor and how far as an educator?

Assessment of learning

Using assessment for learning

Assessment methods used in an

educational project have more impact on

the participant’s learning than teaching

(Miller & Parlett 1974, Brown & Glasner

1999). Tiwai et al (2005)

How do you assess effectively?

What techniques do you use?

Observation is more than watching

Importance of process

Meet early, make the student feel welcome

Concentrate on engagement

Use the paperwork to frame conversations

Complete the initial meeting (development plan)

early, complete the mid point review and

summative assessment

If in doubt seek help and contact the uni early

we are here to help

Major reasons for difficulty in failing is not

following proper process

22

Normal psychological processes that can

inhibit the therapeutic relationship

– normal fears about consequences of

disclosure

– normal sensitivities about autonomy and

confidentiality

– trust in professionals is not automatic!!!

Mentorship Functions

What functions does mentorship provide?

How close are these to clinical

supervision?

NMC on Professional Supervision

Five main functions of supervision

Help clinicians to identify problems and their potential solutions

Increase understanding of professional issues

Improve standards of patient care

Develop skills and knowledge

Enhance the individual’s understanding of their own practice

Engagement, what gets in the

way Attitude especially loss of belief in a person’s ability to succeed

Failure in empathy

Student’s poor experience of previous supervision

Lack of clear agreement/understanding of the purpose and role of mentor

Student feeling out of control

Student anxiety

Not prioritising- structural constraints

(adapted from Chadwick 1996)

Supervision Skills

What skills do we need?

How are these skills different from a 1x1 with a client?

Relationship

Our general skills are extremely important

General Skills

These are vital!!

No seriously- they really are….

Interview skills

The ‘good’ interviewer displays: interest & attention

empathy

warmth

active listening skills

thoughtfulness

reflectiveness

an inability to be shocked

Clarifying and summarising

Conveying positive regard

a non- judgmental stance (but not collusion)

open, non-confrontative (Socratic) questioning

Role-play examples

Encouraging reflection

What is ‘reflection’

“Reflection is a window through which the practitioner

can view and focus self within the context of her own

lived experience in ways that enable her to confront,

understand and work towards resolving the contradictions

within her practice between what is desirable and actual

practice. Through the conflict of contradiction, the

commitment to realise desirable work and understanding

why things are as they are, the practitioner is empowered

to take more appropriate action in future situations” (Johns 2000:34).

Socratic questioning

Socratic Questioning and Method

Westbrook, Kennerley & Kirk, 2011

“Genuine’ curiosity” and interest in the

student

Good Socratic questions:

one which your student knows the answer

to

and

the answer reveals new perspectives

Socratic questioning 2

Assessment questions:

What did you do when that happened?

What did it mean to you when you

thought/did that?

When was the first time that this thought

occurred to you?

Did you have any other thoughts or

feelings about this?

Socratic Method

Concrete questions: structured, information-gathering

questions

Can you tell me what you know about….

Empathic listening

careful attention both to what and how something, is

being said.

Summarising

Synthesising or analysing questions

" Although there are many circumstances in which you

might do this what approch are you most likely to use….

Reflective Questions

What was/is the situation?

How did/do you approach the situation?

Why did/do you approach it in that way?

Was/is it effective?

Why was/is it effective/ineffective?

Does this need to be different?

How could it be approached differently?

BUT, how did Socrates die?

They need to be asked

effectively and carefully

The trial and execution of Socrates took place

in 399 BC. Socrates' death was the result of his

asking philosophical questions.

Socrates was ultimately sentenced to death by

drinking a hemlock based liquid.

Rolfe et al 2001 Framework for

reflective practice

Particularly useful for difficult

conversations

What

So what

Now what

What?

Identify the issue

“What is the most important thing you and

I should be talking about today?”

Clarify the issue

“What’s going on?”, “How long has it been

going on?”, “Am I understanding you

correctly?”

So What?

Determine the impact

“How is this affecting you, others, the

team? How do you feel about this?

Determine future implications

“If nothing changes what are the

implications- how do you feel about this?”

So what?

Examine personal contribution to the issue

“How have you contributed to this-

Good/bad”

What have I noticed about my behaviour in

practice from this?

Now what?

Describe the ideal outcome

“When this is resolved what difference will

it make- how will you feel?”

Action

“What steps can you take to move towards

this goal, what help do you need, how can

I check in with you?”

Take a broad view before final

assessment paperwork

Evidence

Hanson, Rosenberg and Lane 2013

Educators tend to agree on broad global ratings

of performance

On more defined scale agreement between

raters scores for more defined areas of

performance tend to be much lower

This can lead to grade inflation so beware and

consider your views overall as well as

completing paperwork

Responsibility for learning

“I have failed my assignment”

“My placement failed me”

Things to remember

Create a sound structure for meeting up

Prioritise meetings

Concentrate on the relationship

Concentrate on the process

Use your general skills (active listening, reflection, encourage staff reflection through open questions)

Use your agenda/paperwork but don’t be too rigid

Create action plans where appropriate

Any comments or questions